Provider Demographics
NPI:1467911750
Name:BAKER, KAITLEN (MD)
Entity type:Individual
Prefix:
First Name:KAITLEN
Middle Name:
Last Name:BAKER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KAITLEN
Other - Middle Name:
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:844-447-4321
Mailing Address - Fax:515-532-9250
Practice Address - Street 1:1316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:844-474-4321
Practice Address - Fax:515-532-9250
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022035445207R00000X
390200000X
IAMD-53871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program